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Dealing with Your Baby’s Flat Spot

What to do if you suspect your baby has a flat spot on his head

By Lisa Saunders

Todd Turner’s son, Bennett, was only about two weeks old when he and his wife Kelly first brought up a concern to their doctor. Whether in the car seat or crib, Ben’s head constantly cocked to the right. He was also developing a flat spot on the back of his head, on the right side. The nervous first-time parents from Calgary were told to reposition Ben’s head, and that the flat spot would likely correct itself. It didn’t, despite the Turners bringing up their concerns to two more medical professionals, when Ben was four weeks and six weeks old respectively. “Everyone that we talked to said, “It will round out,” says Turner.

At two months old, Ben’s flat spot was causing his face to shift, with one ear pushing forward and his forehead protruding over his right eye. Finally, a public health nurse referred Ben to a flat head-screening clinic at the Alberta Children’s Hospital in Calgary. He was immediately diagnosed with torticollis, a neck muscle disorder that causes the head to tilt to one side. It caused the flat spot, or positional plagiocephaly. Dr. Lonny Ross, a plastic surgeon and director of the Manitoba Centre for Craniofacial Difference at Winnipeg’s Children’s Hospital adds, “Torticollis along with the flattening of the head are common presentations that we see, and both require treatment.”

your child’s cranial development

Positional plagiocephaly is the result of the baby’s head staying in the same position for a prolonged period of time. Constant pressure on a baby’s soft skull and the effects of gravity can produce an asymmetry or flattening of one side of the head, but does not affect brain growth or cause developmental delays.

According to Dr. Ross, there has been an increase in the condition due to two main factors: the Back to Sleep campaign that encourages parents to place their children on their backs to reduce the incidence of Sudden Infant Death Syndrome (SIDS), and products like detachable infant car seats, which put pressure on the back of the skull. Ross says both doctors and patients are experiencing a learning curve, and that parents need to monitor their child’s flat spot and make sure it’s treated appropriately.

treatment options

“I’m probably not even seeing the tip of the iceberg, compared to the number of kids with plagiocephaly that are out there,” says Dr. Ross. Most flat heads will resolve themselves between four to six months of age, as your child develops improved head control and neck movement and is less likely to stay in a fixed position. However, some cases may require further treatment. Last year, the Manitoba Centre received 90 referrals, 25 percent of which required helmet therapy. During therapy, the infant wears a custom-fitted fibreglass moulding helmet that allows for the bones of the skull to expand in the flat areas in response to the underlying growth of the brain. Ben underwent four months of physiotherapy and was recommended for helmet therapy — which he wore for 23 hours a day for four months. The family paid $2,600 for the therapy associated with the helmet (scans, adjustments) — $1,100 was covered by Alberta Healthcare, while $1,500 for the helmet was reimbursed by the Turners’ extended healthcare benefits.

what you can do

To minimize flattening of the head, Dr. Ross recommends:

Put your baby on his stomach several times a day, whether it’s on an activity mat during supervised tummy time, or just lying on your chest. Limit the amount of time your child spends on his back while he’s awake, including sitting in a car seat or infant seat.

If your baby prefers to look in one direction while lying on his back in his crib, place a toy or mobile on the less-preferred side.

If you notice a flat spot, ask your doctor for advice on counter-positioning using a wedge to keep your baby slightly off her back.

In any case, most experts will tell you head flattening is no reason to let your child tummy-sleep. Winnipeg pediatrician Dr. James Carson says since the Back to Sleep program came into effect, SIDS has been reduced by about 50 percent. “Flat heads are unpleasant, but the program’s been a success.” Or, as Turner puts it: “You can cure a flat head, but you can’t cure a SIDS death.”

Ben finished his helmet therapy this past August and it made a remarkable difference in his flat spot, says Turner. “He still has a bit of one, but by the time he’s two years old, it should be so small, it will be unnoticeable.”

Lisa Saunders is a Winnipeg writer with two young daughters and a Labrador retriever. Her husband is on parental leave and loving it!

This story is part of our New Baby Guide. Check it out for more info on bringing home, planning for and surviving having a new baby.